During a recent Verato-sponsored webinar, panelists from SCAN Health Plan and the Alliance of Community Health Plans discussed AI readiness and ways to improve data quality.
Vinay Kulkarni, SCAN Health Group’s Chief Information Officer, emphasized that healthcare identity is complex. In this sector, an individual or entity can shift roles constantly, creating a web of relationships. He highlighted the need for an Enterprise Master Person Index (EMPI) alongside master data management (MDM), noting that householding—while conceptually simple—is difficult to implement.
“Financial systems have mastered this for mortgages, where they can instantly show whether a household member has applied for a loan. In healthcare, we must apply the same logic to members and caregivers. A single member identity should clearly connect to clinical history, legal caregivers, and authorized representatives. Likewise, a provider identity must link to physical locations, tax IDs, and unique digital endpoints, as their payer relationships differ,” Kulkarni explained.
He added that similar identity challenges arise on the member side for benefits and pharmacies, creating an identity crisis for health insurers. To address this, Kulkarni advocated adopting an EMPI to reliably identify the same person over multiple years.
Thomasina Anane, Associate Vice President of Enterprise Analytics at the Alliance of Community Health Plans, illustrated the human cost of inaccurate patient identity data, particularly in prior authorization processes.